These are the dental photographs of a 58-year old man who has been an avid Pan Masala and Gutkha chewer for many years. He was with me for some dental problem. However, when i found something unusual with his mouth and enquired about it, he came out with the proper history.
He told me that about two years ago, another dental surgeon had told him to kick this habit of Pan masala/gutkha chewing. However, he could not go there for follow-up.
Now, listen to his complaints. He is unable to open his mouth fully. Because of this restricted oral opening, he can’t take some food items. He takes food in small bites. This condition is called Oral Submucous Fibrosis (OSF).
Where are the signs of this condition –mainly there are three and all are present in this patient. First, of course, restricted mouth opening because of fibrosis of oral tissues. This is a big problem. I have seen many patients in which this opening became so small that they literally were unable to put anything solid in their mouth. They had to be operated for releasing those fibrous bands to improve oral opening.
Secondly, just a look at the oral mucous membrane –tissues inside an oral cavity – creates a strong suspicion that there is something wrong. In this patient, you notice that his tissues are blanched out and pale yellow. This alongwith loss of elasticity of oral tissues indicates that the person is suffering from oral submucous fibrosis.
Thirdly, if i could let you feel his inside cheek tissues on his right and left side…….oh my God, these felt like a dry leather, may be harder than that! Just imagine a leather shoes which you have not worn for years and when you touch it after many years, how does it feel? — very tough, hard, stiff leather. You will have to trust me that his cheeks were giving that feel only during examination.
In fact, he is still using pan-masala/Gutkha. I have counselled him to leave all this as this condition itself is a pre-cancerous condition.
Such cases are best handled by oral surgeons who know which case to manage with local application of medicines, injections given inside the mouth, and surgery to release those fibrous bands. They have specialized skills to manage such cases. I make it a point to ensure that once i come across any such patient, he says good bye to such harmful habits.
I am presently posted at Lucknow City in Uttar pradesh State of India where i come across many cases of Oral Submucous Fibrosis. Here the use of Pan Masalas/Gutkha is widely prevalent.